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Psychiatry > Psychosis (including schizophrenia) > Flashcards

Psychosis (including schizophrenia) Flashcards

1
Q

give some examples of psychotic symptoms 6

A

hallucinations

delusions

disorganised thought

catatonia

affective distrubance

avolition

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2
Q

how can schizophrenia first rank sympotms be classified 4

A

auditory hallucinations

thought disorders

passivitiy phenomena

delusional perceptions

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3
Q

what types of auditory hallucinations are seen in schizophrenia 3

A

two or more voices discussion the patient in the third person

though echo

voices commenting on the patients behaviour

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4
Q

types of thought disorder seen in schizophrenia 3

A

thought insertion

thought withdrawal

thought broadcasting

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5
Q

describe passivity phenomena seen in schizophrenia 2

A

bodily sensations being controlled by external influence

examples:
-actions/impulses/feelings- experiences which are imposed on the individual or influenced by others

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6
Q

describe delusionsal perceptiosn seen in schizophrenia

A

two stage process
-first normal object is perceived
-then secondly there is a sudden intense delusional insight into the objects meaning for the patient

eg that traffic light is green therefore i am the king

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7
Q

other features of schizophrenia 6

A

impaired insight

incongruiting/bluding of affect (inapporpriate emotion for circumstances)

decreased speech

neologisms: made up words

catatonia-awake but does not respond to people or environment

negative symptoms
-anhedonia (inability to derive pleasure)
-alogia (poverty of speech)
-avolition (poor motivation)

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8
Q

what factors are associated with a poor prognosis in schizophrenia 5

A

strong family history

gradual onset

low IQ

prodromal phase of social withdrawal

lack of obvious precipitants

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9
Q

describe thoguht insertion

A

someone is putting ideas into the patients head

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10
Q

describe thought broadcasting

A

people overhear patients thoughts

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11
Q

describe thought withdrawal

A

thoughts are being taken out of my head

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12
Q

diagnotic criteria for schizophrenia 6

A

symptoms must last for ≥6 months
-at least 1 month of severe symptoms
-marked impairment in work or home function

must have very clear symptoms of 1 of the following or 2 or more if less clear cut:
-all the first rank symptoms:
-
auditory hallucinations

thought disorders

passivitiy phenomena

delusional perceptions

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13
Q

state the 5 schizophrenia subtypes

A

paranoid schizophenia

hebephrenic sschizophrenia

catatonic schizophrenia

undifferentiated schizophrenia

residual schizophrenia

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14
Q

define paranoid schizophrenia

A

delusions and hallucinations dominate
=most common

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15
Q

define hebephrenic schizophrenia

A

age of onset 15-25
poor prognosis
thought disorder and affective distrubance dominate

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16
Q

define catatonic schizophrenia

A

catatonia dominates
-stupor
-posturing
-waxy flexibitly
-negativism

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17
Q

define undifferenitated schizophrenia

A

no specific subtype

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18
Q

define residual schizophrenia

A

negative symptoms dominate

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19
Q

when can prodromal symptoms for schizophrenia start

A

up to 18moths before first episode of psychosis but sometimes just a few days

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20
Q

how are prodromal sympotms of schizophrenia charactereised
-examples of changes 4

A

gradual deterioration in functioning
-sometimes conceptualized as ‘altered life trajectory’

changes:
-transisent and/or lower intensity psychotic syx
-odd (out of character) thoughts, beliefs and behaviours
-concentration problems
-altered affect
-social withdrawal
-reduced interest in daily activities

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21
Q

define schizoaffective disorder

*-treatemetn

A

a vairant of schizophrenia and affective (mood) disorders
-patient exepreinves syx of mood disorder (mania or depression) and schizophrenia at the same time (within days) and of the same intensiitivty

*-manage both conditions
-antipsychotics
-mood stabilizers

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22
Q

defire schizotypal disorders

A

personality disorder
-may represent parital expression of schizophrenia
-usually treated without medication

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23
Q

define schizophreniform disorder

A

those disorders fail to meet threshold for schizophrenia (usually duration of psychosi) but have syx of schizophrenia and deitriotiation in function

treated with antipsychotics

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24
Q

who gets schizophrenia4

A

strong genetic compoenet

later onset in women

lower socioectomic

higher incidence in immigrants/minority ethic groups

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25
Q

biological risk factors for schizophrenia 4

A

familial geentic risk

structual brain cahges

intelecual impaired

substance use

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26
Q

psychiligcal risk factors for schizophrenia 2

A

probelm with learning. attention, planning

biases in emotional and reasoning processes

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27
Q

social risk factors for schizophrenia 3

A

urban birth and rearing

social adversity and trauma

migration and stressful life events all increase

28
Q

dopamine abnormalites in schizophrenia 2

A

nigrostriatal pathways
-excessive dopamie transmission assoc w positive syx

mesocrotical & mesolimbic
-reduced dopamine transimson-> impaired cognition and possible negative syx

29
Q

brain changes in schizophrenia

A

cortex, hippocampus/amygdal reduced
ventircles enlarged

decreased blood flow in areas involved in frontal lobe in tests of executive function

30
Q

acute manaegmnt of schizophrenia 5

A

risk assessment

phsyucial health chekc

drug treatmetn

education

family education + support

psychosocial interventions

31
Q

aspects of maintanence managemtn for schizophrenia 4

A

MDT approach

co-morbitidy checks

side effect monitoring

social/occupational recovery

32
Q

describe the role of psychological interventiosn for schizophrenia 5

A

recommned in all managemtn plans
-prmote quick recovery and relapse prevention

-strong evidence for EARLY CBT
-general or targeted at auditory hallucinations

address acute syx first then residual syx

if concurrent substances missue - abstiennce improves overall prognosis

work with family

33
Q

before starting an antipsychotic what needs to be checked

A

ask about personal and FHx of:
-DM
-HT
-CVD

give advice on weight, diet and excersies

perform:
-BP
-weight
-BM
-lipid profile FBC

34
Q

what needs to be completed before a patient is started on clozoapine

A

ECH

35
Q

what needs to be monitored when on an antipsychotic and how ofeter

A

6 monthly monitoring of:
-LFT
-U&Es
-Prolactin
-weight
-HbA1c

36
Q

what is first line for schizophrenia (drug class)

A

second generation antipsychotics

37
Q

examples of second generation antipsychotics 5
-why are they preferred

A

5HT2A and D2 antagnoists
amisulpride (D2)
olanzapine (D2)
quetiapine (D2)
repseridone (D2)
clozapine (5HT2A)

lower risk of extrapyramidal side effects compared to 1st generation APs but more metabolic side effects:
-weight gain
-hyperglycaemia
-dyslipidaemia

38
Q

exaamples of 1st generation antipsychotics 2
-why are they second line for treatment of schizophrenia

A

D2 antagnoists
chlorpromazine
haloperidol

-can extrapyridmal side effects
-often the reason patients stop taking their tablets

39
Q

an example of third generation antipsychots 1

A

dopamine partial agnoists
only licensed TGA is aripiprazole

40
Q

when is clozapine used
-why can it be dangerous

A

used for treatment-resistnat schizophrenia
has associated decreased sucicde risk
-

agranulocytosis risk in first year
-needs specialist monitoring

41
Q

state some examples of extrapyrmidal side effects and how to treat these 4

A

parkinsonism
-decrease dose
-change to 2nd gen AP

acute dystonia -uncontrolled muscle movements (can occur within hours of starting AP)
-give procyclidine IM/IV
-may take up to 30 minutes to work

akathisia (subjective sense of psychomotor restlessness)
-within hours to weeks of starting AP
-decrease dose or change to 2nd gen AP
may need propanolol ± cyproheptadine

tardive dyskinesia (chewing, grimaces, choreoathetoisis(episodes of unwanted, uncontrollable movements, often of the muscles in the arms, legs, face, and body.))
-can be irreversible
-try tetrabenzine

42
Q

regarding antipsychotic side effects
-side effects of dopamine blockades 2

A

EPSEs

TD

43
Q

regarding antipsychotic side effects
-side effects of alpha adrenergic blockage 2

A

dizziness

hypotension

44
Q

regarding antipsychotic side effects
-side effects of histamine blockade 2

A

drowsieness

weight gain

45
Q

regarding antipsychotic side effects
-side effects of muscarinic blockade 3

A

dry mouth

constipation

urine retention

46
Q

common co morbitities to schizophrenia 6

A

alcohol/substance missure

social anxiety/ anxiety disordeers

trauma/PTSD

low confidence/self esteme

mood disorder

aspergers

47
Q

whn are outcomes worse with schizoprhenia 4

A

men

substance misure

low IQ

long duration of untreated psychosis

48
Q

lifestyle issues with antipsychotic use and how to combat 3

A

hunger after taking medication
-consider bedtime dose

increased thirst
-suggest water or sugar free alternative

smoking-
-induces metbalisisma dn thus reduces antispychoitc plasma level
-increase dose and review if they quit

include targeted health promotion
-diet
-physical exercise
-smoking cessation

49
Q

common side effects of antipsychotic drugs 6

A

extrapyrmaidal side effects

hyperprolactinaemia

sexual dysfunction

weight gain

DM

CV effects

daytime drowsiness

50
Q

another name for substance induced psychosis

A

toxic psychosis or drug induced psychosis

51
Q

what is an important point regarding substance induced psychosis

A

25% of people with substance induced psychosis go onto be diagnosed with schizoprhenia

52
Q

examples of substances that can cause substance induced psychosis 7

A

alcohol

opiods

cannabinoid

benzos

stimulants: amphetamines

cocaine

hallucinogens

volatile inhalants

53
Q

what medications can cause substance induced psychosis 3

A

fluoroquinolone

dextromorpha

certainhigh dose antihistamines

54
Q

management of substance induced psychosis 2

A

hospitlaisation for detoxification and

possible antipyshcoitcs/benzo for symptom control

55
Q

define delusiounal disorder

A

firmly held false belief (delusions)

persist for at least 1 month
-without other syx of psychosis

56
Q

how is delusional disorder distinguied from schizophrenia

A

precense of delusions without any other syx of psychosis

57
Q

how are delusions distinguished from mistkaen belifed s

A

remain unchnaged in face of clear, resonable evidence to the contrary

58
Q

define bizzare vs nonbizarre delusison

A

non-bizzare- invovle situations that could occur
eg being followed, infected

bizarre- implausible situations such as believing someone removed internal organs with no scar

59
Q

who gets delusional disorder

A

relatively uncommon
-onset involutional
-middle or late adult life

patients may have a pre-exisitng paranoid personality disorder
-pervasive distrust & suspicion of others
-can begin in early adulthood

60
Q

what is delusional disorder in older patients

A

sometimes called paraphrenia
-can coexist with mild dementia

61
Q

give a brief overview of the subtypes of delusional disorder 5

A

erotomaitc-patinets beleive another person is in love with them

grandiose
-great talent or important discovery

jealous- spouse/lover is unfaithful

persecutory
-being plotted against, spied on or harassed

somatic - bodily function
-have physical deformity, odor, parasite

62
Q

diagnosis of delusional disorder

A

clinical evaluation and assessement
rule out other specific conduction assoc w delusions

63
Q

managemnt of delusional disorder

A

estabilish effective patient doctor relationship

manage complications

sometimes antipyschotics

64
Q

define puerperal psychosis

A

a rare complication of post partum depression

65
Q

risk factors for postpartum psychosis

A

Hx of bipolar, schizoaffective disorder

FHx or personal Hx of postpartum psychosis

first rpegnnacy

discontinnuation of psych meds for pregnancy

66
Q

management of postpartum psychosis 3

A

medical emergency
-need inpatinet care and for baby

use of antipsychotics and mood stabilizers

ECT shows good evidence

Psychiatry (21 decks)

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